DEEPAK RATHIBE.
                                                                      Surveyor and Loss Assessor & Valuer
                                                                                    Fire,Motor& Engineering)
 IIISLA Member Ship No.-Associate-A/W/04882
                                                                                                          SLA-73076
 GSTIN:08ACUPR3734N1ZO
                                                                            Mobile :94149-14640,99822-14640
 PAN :ACUPR3734N


                                                 PRE RECEIPT
 Bill Number: DR/03-2021/1008                                                Date: 06-03-2021
 Insurer                                     Bajaj Allianz General Insurance Company Limited
                                                 23rd Floor,4,Hathroi Fort,Gopal bari Ajmer road,Jaipur
                                                 GSTIN-08AABCB5730G1ZX
 Claim Number                          OC-21-1401-1826-00000289
 Insured                                    Mr.Hasmukh Das
 Policy Number                          OG-21-3278-1826-00000002
 Report number                          DR/Motor/03-2021/1008
 Place of inspection                     Praveen Motors-Bali
 Vehicle Regd. Number               RJ-24-SN-1461
 Professional Fees                                                                               750.00/-
  Conveyance-For Final                                                                        2325.00/-
  Distance between Jodhpur & Bali is 155.00 km.
 Total distance covered=155.00x 2=310.00 km
 Conveyance @07.50/-=310.00 x 07.50/-=2325.00/-
 Photographs charges-CD                                                                       30.00/-
 DA                                                                                                   175.00/-
  Regd Letters                                                                                          0.00/-
 TOTAL                                                                                          3280.00/-
 CGST @ 09.00% = 295.20/- & SGST @ 09.00% = 295.20/-                                590.40/-
  TOTAL Rs/-                                                                                   3870.00/-
(Rs/- Three Thousand Eight Hundred Seventy Only)
      For NEFT Fund Transfer:-
      Bank Name:Union Bank of India
      IFSC:UBIN 0550388                                                            SLA
      A/C Number:503802010011146                                            7307
      MICR Code:342026003
      GSTIN-08ACUPR3734N1ZO                              DEEPAKRATHI




            C/o. Annkoot Agro Food,T-2, Mandore Mandi, Jodhpur-342 006 (Raj.)

---PAGE END---